Mechanism of action of
antidepressant medications

by
Feighner JP
J Clin Psychiatry 1999; 60 Suppl 4:4-11; discussion 12-3


ABSTRACT

The psychopharmacology of depression is a field that has evolved rapidly in just under 5 decades. Early antidepressant medications--tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs)--were discovered through astute clinical observations. These first-generation medications were effective because they enhanced serotonergic or noradrenergic mechanisms or both. Unfortunately, the TCAs also blocked histaminic, cholinergic, and alpha1-adrenergic receptor sites, and this action brought about unwanted side effects such as weight gain, dry mouth, constipation, drowsiness, and dizziness. MAOIs can interact with tyramine to cause potentially lethal hypertension and present potentially dangerous interactions with a number of medications and over-the-counter drugs. The newest generation of antidepressants, including the single-receptor selective serotonin reuptake inhibitors (SSRIs) and multiple-receptor antidepressants venlafaxine, mirtazapine, bupropion, trazodone, and nefazodone, target one or more specific brain receptor sites without, in most cases, activating unwanted sites such as histamine and acetylcholine. This paper discusses the new antidepressants, particularly with regard to mechanism of action, and looks at future developments in the treatment of depression.
TCAs
SSRIs
RIMAs
Classes
Relapse
Mirtazapine
Mechanisms
The long wait?
Antidepressants
SSRIs and SNRIs
SSRI mechanisms
Serotonin and dopamine
Acetylcholine and dopamine
Noradrenaline and serotonin
Noradrenaline and dopamine
Comparisons and metabolites
Antidepressants and cell growth
Neuropharmacology of serotonin
Antidepressants and the unexplained
How effective are commonly prescribed antidepressants?


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